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Providers for group practice enrollment. •. Refer to Addendum 3 to add additional license and certification information.TDI Form NumberDescriptionFile FormatLanguageDWC003Employer's wage statement. Rev. Workers' Disability Compensation Agency. Forms. Workers' Disability Compensation Agency. Forms. For additional information, see the Online Public Meeting Notice. The Alaska Workers' Compensation Board will conduct a full board meeting on May 18-19, 2023. Form nameVersion dateNotesAffidavit of Significant Financial Hardship (AS01)June 2018Legislative changesDisability Status Report (DS01)September 2012Employee's Claim Petition (EC04)June 2018Legislative changes SIF-2 Addendum F207-002-000 must be attached to SIF-2's dated prior to February 2021. These benefits are the responsibility of the self-insured employer or the employer's worker's compensation insurance carrier.
